Chest pain is one of the most frightening symptoms a person can have. It is sometimes difficult even for a doctor or other medical professional to tell what is causing chest pain and whether it is life-threatening.
Any part of the chest can be the cause of the pain including the heart, lungs, esophagus, muscle, bone, and skin. Because of the complex nerve distribution in the body, chest pain may actually originate from another part of the body. The stomach or other organs in the belly (abdomen), for example, can cause chest pain.
If you are having severe pain, crushing, squeezing, or pressure in your chest that lasts more than a few minutes, or if the pain moves into your neck, left shoulder, arm, or jaw, go immediately to a hospital emergency department. Do not drive yourself. Call 911 for emergency transport.
Potentially life-threatening causes of chest pain are heart attack, angina, aortic dissection, pulmonary embolism, spontaneous pneumothorax, perforated viscus, or cocaine-induced chest pain.
Heart attack occurs when blood flow to the arteries that supply the heart (coronary arteries) becomes blocked. With decreased blood flow, the muscle of the heart does not receive enough oxygen. This can cause damage, deterioration, and death of the heart muscle. Treatment for a heart attack is aimed at increasing blood flow by opening arteries blocked or narrowed by a blood clot.
Medicines used to achieve this include aspirin, heparin, and clot-busting (thrombolytic) drugs. Other medications can be used to slow the heart rate, which decreases the workload of the heart and reduces pain. Angioplasty is a way of unblocking an artery.
Angiography is done first to locate narrowing or blockages. A very thin plastic tube called a catheter is inserted into the artery. A tiny balloon on the end of the catheter is inflated. This expands the artery, providing a wider passage for blood. The balloon is then deflated and removed. Sometimes a small metal scaffold called a stent is placed in the artery to keep it expanded.
Angina is chest pain related to an imbalance between the oxygen demand of the heart and the amount of oxygen delivered via the blood. It is caused by blockage or narrowing of the blood vessels that supply blood to the heart. Angina is different from a heart attack in that the arteries are not completely blocked, and it causes little or no permanent damage to the heart.
“Stable” angina occurs repetitively and predictably while exercising and goes away with rest. “Unstable” angina results in unusual and unpredictable pain not relieved totally by rest, or pain that actually occurs at rest.
Treatment of angina is directed at relieving chest pain that occurs as the result of reduced blood flow to the heart. The medication nitroglycerin is the most widely used treatment. Nitroglycerin dilates (widens) the coronary arteries. It is often taken under the tongue (sublingually).
People with known angina may be treated with nitroglycerin for three doses, five minutes apart. If the pain remains, nitroglycerin is given by IV, and the patient is admitted to the hospital and monitored to rule out a heart attack.
Long-term treatment after the first episode of angina focuses on reducing risk factors for atherosclerosis and heart disease.
The aorta is the main artery that supplies blood to the vital organs of the body, such as the brain, heart, kidneys, lungs, and intestines. Dissection means a tear in the inner lining of the aorta. This can cause massive internal bleeding and interrupt blood flow to the vital organs.
A pulmonary embolus is a blood clot in one of the major blood vessels that supplies the lungs. It is a potentially life-threatening cause of chest pain but is not associated with the heart.
Anyone with a presumed or documented pulmonary embolism requires admission to the hospital. Treatment usually includes supplemental oxygen and medication to prevent further clotting of blood, typically heparin. If the embolism is very large, clot-busting medications are given in some situations to dissolve the clot.
Some people undergo surgery to place an umbrella-like filter in a blood vessel to prevent blood clots from the lower extremities from moving to the lungs. Spontaneous pneumothorax is often called a collapsed lung, this condition occurs when air enters the saclike space between the chest wall and the lung tissue.
Normally, negative pressure in the chest cavity allows the lungs to expand. When a spontaneous pneumothorax occurs, air enters the chest cavity. When the pressure balance is lost, the lung is unable to re-expand. This cuts off the normal oxygen supply in the body.
A pneumothorax without symptoms involves six hours of hospital observation and repeat chest x-rays. If the size of the pneumothorax remains unchanged, the patient is usually discharged with a follow-up appointment in 24 hours. If the patient develop symptoms or the pneumothorax enlarges, they will be admitted to the hospital.
The patient will undergo catheter aspiration or have a chest tube inserted to restore negative pressure in the lung sac.
A perforated viscus is a hole or tear in the wall of any area of the gastrointestinal tract. This allows air to enter the abdominal cavity, which irritates the diaphragm, and can cause chest pain. Any disruption or perforation of the intestinal tract (viscus) is a potentially life-threatening emergency. Immediate surgery may be required.
Lastly, cocaine causes the blood vessels in the body to constrict. This can decrease blood flow to the heart, causing chest pain. Cocaine also accelerates the progression of atherosclerosis, a risk factor for a heart attack.
Furthermore, causes of chest pain that are not immediately life-threatening include Acute pericarditis that is an inflammation of the pericardium, which is the sac that covers the heart. Similarly, mitral valve prolapse is an abnormality of one of the heart valves in which the “leaves” of the valve bulge into the upper heart chamber during contraction.
When this occurs, a small amount of blood flows backward in the heart. This is believed by some to be a cause of chest pain in certain people, although this has not been proven with certainty. Pneumonia can also cause chest pain. Pneumonia is an infection of the lung tissue. Chest pain occurs because of inflammation to the lining of the lungs. Pneumonia is treated with antibiotics, and pain medication is given for chest wall tenderness.
Additionally, chest pain from esophageal disorders can be an alarming symptom because it often mimics chest pain from a heart attack. The three major esophageal disorders that cause chest pain; 1) acid reflux (GERD), 2) esophagitis, and 3) esophageal spasm, are treated with antacid therapy; antibiotic, antiviral, or antifungal medication; medication to relax the muscles of the esophagus; or some combination of these.
Herpes zoster, also known as shingles, this is a reactivation of the viral infection that causes chickenpox. With shingles, a rash occurs, usually only on one small part of the body. The pain, often very severe, is usually confined to the area of the rash. The pain may precede the rash by 4-7 days. Risk factors include any condition in which the immune system is compromised, such as advanced age, HIV, or cancer.
Herpes zoster is highly contagious to people who have not had chickenpox or have not been vaccinated against chickenpox for the five days before and the five days after the appearance of the rash.
Costochondritis is an inflammation of the cartilage between the ribs. With this condition pain is typically located in the mid-chest, with intermittently dull and sharp pain that may be increased with deep breaths, movement, and deep touch.
Lastly, we would like to mention that no matter what the cause of chest pain, regular follow-up visits with your health care provider are important. This will help you remain as healthy as possible and prevent worsening of your condition.